A Multidisciplinary Approach to the Classification and Management of Intestinal Failure: Knowledge in Progress.

Intestinal failure (IF) is a debilitating condition characterized by the insufficient function of the gastrointestinal tract to absorb nutrients and fluids essential for life. This review consolidates recent advancements and challenges in managing IF among adult and pediatric populations, highlighting differences in etiology, management, and outcomes. Over the recent years, significant strides have been made in the nutritional and medical management of IF, significantly reducing mortality rates and improving the quality of life for patients. Key advancements include the development and availability of glucagon-like peptide-2 (GLP-2) analogs, improved formulations of parenteral nutrition, and the establishment of specialized interdisciplinary centers. Short bowel syndrome (SBS) remains the predominant cause of IF globally. The pediatric segment is increasingly surviving into adulthood, presenting unique long-term management challenges that differ from adult-onset IF. These include the need for tailored nutritional support, management of IF-associated liver disease, and addressing growth and neurodevelopmental outcomes. The therapeutic landscape for IF continues to evolve with the development of new treatment modalities and better understanding of the condition's pathophysiology. However, disparities in treatment outcomes between children and adults suggest the need for age-specific management strategies. This review underscores the importance of a nuanced approach to IF, incorporating advancements in medical science with a deep understanding of the distinct needs.

Does the Presence of Matted Nodes in Colon Adenocarcinoma Influence 5-Year Overall Survival?

Background and Objectives: Colon cancer (CC) is prevalent globally, constituting 11.9% of cases in Mexico. Lymph node metastases are established prognostic indicators, with extracapsular lymph node extension (ENE) playing a crucial role in modifying prognosis. While ENE is associated with adverse factors, certain aspects, like matted nodes (lymph node conglomerates), are underexplored. Matted nodes, clusters of lymph nodes infiltrated by cancer cells, are recognized as an independent prognostic factor in other cancers. This study investigates the prognostic implications of matted nodes in CC. Materials and Methods: From a retrospective analysis of 502 CC consecutive cases treated with colectomy (2005-2018), we identified 255 (50.8%) cases with lymph node metastasis (our study group), which were categorized into two groups: (1) lymph node metastasis alone (n = 208), and (2) lymph node metastasis with matted nodes (n = 47). A comparative survival analysis was performed. Results: Of the 255 patients, 38% had lymph node metastasis. Patients with matted nodes (18.4%) showed an association with higher pN stage and lymphovascular invasion. The 5-year survival rate for patients with matted nodes was 47.7%, compared to 60% without (p = 0.096); however, this association demonstrated only a statistical tendency. Multivariate analysis identified clinical stage and adjuvant chemotherapy use as independent factors contributing to survival. Conclusions: This study underscores matted nodes as potential prognostic indicators in CC, emphasizing their association with higher pN stage and reduced survival. Although the patients with matted nodes showed lower survival, this figure did not search statistical significance, but a tendency was detected, which necessitates precise further research, which is essential for validating these findings and integrating matted nodes into the broader context of colorectal cancer management.

Preliminary insights of the genetic diversity and invasion pathways of Cedrela odorata in the Galapagos Islands, Ecuador.

Cedrela odorata is considered the second most invasive tree species of the Galapagos Islands. Although it is listed in CITES Appendix II and there are population losses in mainland Ecuador, in Galapagos it is paradoxically a species of concern due to its invasive potential. Genetic studies can shed light on the invasion history of introduced species causing effects on unique ecosystems like the Galapagos. We analyzed nine microsatellite markers in C. odorata individuals from Galapagos and mainland Ecuador to describe the genetic diversity and population structure of C. odorata in the Galapagos and to explore the origin and invasion history of this species. The genetic diversity found for C. odorata in Galapagos (H e = 0.55) was lower than reported in the mainland (H e = 0.81), but higher than other invasive insular plant species, which could indicate multiple introductions. Our results suggest that Ecuador's northern Coastal region is the most likely origin of the Galapagos C. odorata, although further genomic studies, like Whole Genome Sequencing, Rad-Seq, and/or Whole Genome SNP analyses, are needed to confirm this finding. Moreover, according to our proposed pathway scenarios, C. odorata was first introduced to San Cristobal and/or Santa Cruz from mainland Ecuador. After these initial introductions, C. odorata appears to have arrived to Isabela and Floreana from either San Cristobal or Santa Cruz. Here, we report the first genetic study of C. odorata in the Galapagos and the first attempt to unravel the invasion history of this species. The information obtained in this research could support management and control strategies to lessen the impact that C. odorata has on the islands' local flora and fauna.

Cedrela odorata es considerada la segunda especie más invasora de árboles en las Islas Galápagos. Esta especie está catalogada en el Apéndice II de CITES y sus poblaciones se encuentran amenazadas en Ecuador continental, pero paradójicamente en Galápagos es una especie de preocupación por su potencial invasor. Estudios genéticos pueden ayudar a entender la historia de invasión de especies introducidas que causan efectos en ecosistemas únicos como Galápagos. En este estudio, analizamos 9 marcadores microsatélites en individuos de Galápagos y Ecuador continental para describir la diversidad genética y estructura poblacional de C. odorata en Galápagos y explorar el origen e historia de invasión de esta especie. La diversidad genética encontrada para C. odorata en Galápagos (H e = 0.55) fue menor que la reportada en continente (H e = 0.81), pero mayor que la de otras especies de plantas insulares invasoras, lo que podría sugerir múltiples introducciones de esta especie a Galápagos. Nuestros resultados sugieren que la costa norte ecuatoriana es el origen más probable de C. odorata en Galápagos, aunque más estudios, como secuenciación del genoma completo, Rad­Seq y/o análisis de SNPs, son necesarios para confirmar este hecho. Además, de acuerdo con los escenarios propuestos, es posible que C. odorata haya sido introducida primero a San Cristóbal y/o Santa Cruz desde Ecuador continental. Después de estas introducciones iniciales, parece haber llegado a Isabela y Floreana desde San Cristóbal o Santa Cruz. Este es el primer estudio genético de C. odorata en Galápagos y el primer intento de esclarecer la historia de invasión de esta especie. La información obtenida en esta investigación podría apoyar estrategias de manejo para disminuir el impacto que C. odorata tiene sobre la flora y fauna nativa de estas islas.

Association of Dietary Patterns with Cardiovascular Disease Risk Factors in Mexican Adults: Insights from a Cross-Sectional Descriptive Study.

Dietary patterns (DPs) are an essential tool to analyze the relationship between diet and health as they have presented an association with the incidence of chronic non-communicable diseases. Therefore, the aim of this study was the identification and characterization of DPs and their association with cardiovascular risk factors. For this purpose, a cross-sectional descriptive study was carried out in 165 Mexican adults, including dietary intakes derived from a validated food frequency questionnaire, clinical history, anthropometry, and biochemical biomarkers using standardized procedures for glucose, total cholesterol, triglycerides, LDL-c, and HDL-c. DPs were identified through principal component analysis and ordinal logistic regression was used to examine associations between DPs and cardiovascular disease risk factors. Three DPs were identified: Mexican Fast-Food, Variety-Food, and Healthy-Economic, with a high prevalence of overweight and obesity (78%). Having a high adherence to a Mexican Fast-Food pattern (OR 1.71 CI 1.4-2.8), being sedentary (OR 4.85 2.32-10.15) and smoking (0R 6.4 CI 2.40-16.9) increased the risk of having a high scale of risk factors (four or more risk factors simultaneously). In conclusion, the Mexican Fast-Food pattern showed an increase in the risk of having multiple risk factors, while a sedentary lifestyle and overeating were largely responsible for the prevalence of overweight and obesity in this group of Mexican adults.

Subungual Keratoacanthoma: Typical and Atypical Presentations of an Uncommon Nail Tumor.

Introduction: Keratoacanthoma (KA) is a group of tumors of epidermal origin with controversial nature. Subungual keratoacanthoma (SUKA) is a rare and destructive variant with more aggressive behavior. SUKA appears as a rapidly growing, painful tumor beneath the nail plate that rapidly progresses to a mass that can measure up to 2 cm. The toe location is unusual. The diagnosis must be made based on the correlation of clinical, radiological, and histopathological findings. Case Presentation: We present two cases of patients diagnosed with SUKAs with different clinical presentations which ranged from very typical to uncommon one. Both cases were treated with simple excision without recurrences. Conclusion: SUKA is a rare subungual tumor. Nail bed location represents a more difficult diagnostic challenge. SUKA should be suspected in the context of persistent and progressive pain on a finger or toe, once more frequent painful tumors have been ruled out.

Solid Lipid Nanoparticles (SLN) and Nanostructured Lipid Carriers (NLC) Prepared by Microwave and Ultrasound-Assisted Synthesis: Promising Green Strategies for the Nanoworld.

Many pharmaceutically active molecules are highly lipophilic, which renders their administration and adsorption in patients extremely challenging. Among the countless strategies to overcome this problem, synthetic nanocarriers have demonstrated superb efficiency as drug delivery systems, since encapsulation can effectively prevent a molecules' degradation, thus ensuring increased biodistribution. However, metallic and polymeric nanoparticles have been frequently associated with possible cytotoxic side effects. Solid lipid nanoparticles (SLN) and nanostructured lipid carriers (NLC), which are prepared with physiologically inert lipids, therefore emerged as an ideal strategy to bypass toxicities issues and avoid the use of organic solvents in their formulations. Different approaches to preparation, using only moderate amounts of external energy to facilitate a homogeneous formation, have been proposed. Greener synthesis strategies have the potential to provide faster reactions, more efficient nucleation, better particle size distribution, lower polydispersities, and furnish products with higher solubility. Particularly microwave-assisted synthesis (MAS) and ultrasound-assisted synthesis (UAS) have been utilized in the manufacturing of nanocarrier systems. This narrative review addresses the chemical aspects of those synthesis strategies and their positive influence on the characteristics of SLNs and NLCs. Furthermore, we discuss the limitations and future challenges for the manufacturing processes of both types of nanoparticles.

Bioethics and public health policies in Mexico.

INTRODUCTION: Bioethics, as a reference framework for collective decision-making in plural societies, represents a valuable tool for the development, implementation and evaluation of public policies in order to address structural deficiencies and contexts of vulnerability that disproportionately affect certain sectors of the population. OBJECTIVE: To provide guidelines for the strengthening of actions, programs and public policies aimed at addressing the ethical dilemmas and challenges faced by health personnel. METHODS: A documentary research process was carried out on the moral context faced by health personnel at the federal level. RESULTS: Health budget programs show important gaps in their design, implementation or evaluation, which give rise to various ethical and human rights problems. CONCLUSIONS: Given the difficulty for reaching agreements or generating common understanding with regard to public health problems, bioethics contributes to a systematic approach to the challenges of the National Health System, for the safeguarding of the human rights of users, as well as of the integrity of its institutions.

INTRODUCCIÓN: La bioética como marco referencial para la toma de decisiones colectivas en sociedades plurales representa una valiosa herramienta para el desarrollo, implementación y evaluación de las políticas públicas a fin de abordar deficiencias estructurales y contextos de vulnerabilidad que afectan desproporcionalmente a ciertos sectores de la población. OBJETIVO: Brindar pautas para el fortalecimiento de las acciones, programas y políticas públicas orientadas al abordaje de los dilemas y desafíos éticos que enfrenta el personal de salud. MÉTODOS: Se llevó a cabo un proceso de investigación documental sobre el contexto moral que enfrenta el personal de salud a nivel federal. RESULTADOS: Los programas presupuestarios en salud presentan lagunas importantes en su diseño, implementación o evaluación, que dan lugar a diversos problemas éticos y de derechos humanos. CONCLUSIONES: Ante la dificultad de alcanzar acuerdos o generar entendimiento común en relación con problemas públicos en salud, la bioética contribuye al abordamiento sistemático de los desafíos del Sistema Nacional de Salud, para la salvaguarda de los derechos humanos de los usuarios, como también de la integridad de sus instituciones.

Bioética y políticas públicas en salud en México / Bioethics and public health policies in Mexico

Resumen Introducción: La bioética como marco referencial para la toma de decisiones colectivas en sociedades plurales representa una valiosa herramienta para el desarrollo, implementación y evaluación de las políticas públicas a fin de abordar deficiencias estructurales y contextos de vulnerabilidad que afectan desproporcionalmente a ciertos sectores de la población. Objetivo: Brindar pautas para el fortalecimiento de las acciones, programas y políticas públicas orientadas al abordaje de los dilemas y desafíos éticos que enfrenta el personal de salud. Métodos: Se llevó a cabo un proceso de investigación documental sobre el contexto moral que enfrenta el personal de salud a nivel federal. Resultados: Los programas presupuestarios en salud presentan lagunas importantes en su diseño, implementación o evaluación, que dan lugar a diversos problemas éticos y de derechos humanos. Conclusiones: Ante la dificultad de alcanzar acuerdos o generar entendimiento común en relación con problemas públicos en salud, la bioética contribuye al abordamiento sistemático de los desafíos del Sistema Nacional de Salud, para la salvaguarda de los derechos humanos de los usuarios, como también de la integridad de sus instituciones.

Abstract Introduction: Bioethics, as a reference framework for collective decision-making in plural societies, represents a valuable tool for the development, implementation and evaluation of public policies in order to address structural deficiencies and contexts of vulnerability that disproportionately affect certain sectors of the population. Objective: To provide guidelines for the strengthening of actions, programs and public policies aimed at addressing the ethical dilemmas and challenges faced by health personnel. Methods: A documentary research process was carried out on the moral context faced by health personnel at the federal level. Results: Health budget programs show important gaps in their design, implementation or evaluation, which give rise to various ethical and human rights problems. Conclusions: Given the difficulty for reaching agreements or generating common understanding with regard to public health problems, bioethics contributes to a systematic approach to the challenges of the National Health System, for the safeguarding of the human rights of users, as well as of the integrity of its institutions.

Treatment of refractory ascites: Current strategies and new landscape of non-selective beta-blockers.

Ascites is the fluid accumulation in the peritoneal cavity, and it is the consequence of a wide variety of entities, being liver cirrhosis the most common one. In this kind of patients, the development of ascites results from splanchnic vasodilation; decreased effective circulating volume; the activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system; and a systemic inflammatory process. Its management is diverse and depends on the severity of the hemodynamic disturbance and other clinical manifestations. In recent years, therapeutic strategies have been developed, but they tend to result unconventional, so new evidence demonstrates the advantages of non-selective beta-blockers for the survival rate of patients with end-stage cirrhosis and ascites.

Meningioma como causa poco común de hiposmia. A propósito de un caso / Meningioma as an infrequent cause of hyposmia. Case report

Resumen La afectación del sentido del olfato puede pasar desapercibida en gran parte de los pacientes, siendo únicamente valorada cuando la alteración es importante. Sin embargo, la hiposmia es un síntoma asociado a numerosas patologías, de menor a mayor gravedad. Este sentido está relacionado con nuestros recuerdos y puede alertarnos de potenciales amenazas. Como médicos especialistas en Otorrinolaringología debemos estar alerta ante determinados síntomas que orienten a posible etiología central. Presentamos el caso de una mujer de 39 años que acudió al Servicio de Otorrinolaringología del Hospital General Universitario Morales Meseguer derivada por hiposmia de un año de evolución con cervicalgia y cefalea occipital progresiva, sin otra sintomatología asociada. La exploración otorrinolaringológica resultó normal. Debido a la persistencia sintomática se solicitó una tomografía computarizada de senos paranasales con hallazgos de masa intracraneal extraaxial compatible con meningioma de fosa craneal anterior.

Abstract The affectation of smell can go unnoticed in a great part of the patients, being only valued when the alteration is important. However, this sense is related to our memories and can alert us to potential threats. As otolaryngologists we must be alert to certain symptoms that may lead to a possible central aetiology. We present the case of a 39-year-old woman who went to the otolaryngology service at Morales Meseguer General University Hospital due to one-year evolution of hyposmia with cervicalgia and progressive occipital headache, with no other symptoms associated. The otolaryngology examination was anodyne. In view of symptomatic persistence, a paranasal sinus computed tomography scan was requested with findings of extra-axial intracranial mass compatible with anterior cranial fossa meningioma.

Genetic characterization of a collection of Tsantsas from Ecuadorian museums.

Tsantsas are shrunken human heads originally made for ceremonial purposes by Amazonian indigenous groups of the Shuar and Achuar family, previously called Jivaroan tribes. A significant demand of these objects during the first half of the 20th century led to the manufacture of counterfeit shrunken heads for commercial purposes. For museums where these collections are held, as well as for the indigenous groups who claim their ownership, it is important to identify the origin and authenticity of these tsantsas. We hypothesized that a collection of 14 tsantsas from 3 different museum collections in Ecuador are human and aimed to characterize their sex and potential origin. We amplified the amelogenin gene and performed a high resolution melting analysis to determine their human origin and characterize their sex. We also analyzed a fragment (16209-16402) from the HVR-1 region to identify the mtDNA haplogroups present in the tsantsa collection. Our exploratory results show that all the tsantsas are human and that the collection is comprised of 13 males and 1 female. A total of seven mtDNA haplogroups were found among the tsantsa collection using the mtDNA EMPOP database. These results show a predominance of the Amerindian mtDNA haplogroups B, C and D. Additional principal component analysis, genetic distance tree and haplotype network analyses suggest a relationship between the tsantsa specimens and Native American groups.

Spontaneous Pneumomediastinum in nCOVID-19 infection: a case report / Pneumomediastino espontáneo en la infección por nCOVID-19: un reporte de caso

Spontaneous pneumomediastinum (SP) is a clinical entity characterized by the presence of interstitial air in the mediastinum. The purpose of this study was to further examine a rare SP case in a 60-year-old male, with COVID-19. In conclusion, SP is an uncommon complication in COVID-19, and the recognition of clinical characteristics is crucial since early identification plays a significant role in the maintenance or recovery of the disease..(Au)

El neumomediastino espontáneo (NE) es una entidad clínica caracterizada por la presencia de aire intersticial en el mediastino. El propósito de este estudio fue examinar más a fondo un caso raro de NE en un hombre de 60 años con COVID-19. En conclusión, el NE es una complicación poco común de COVID-19 y el reconocimiento de las características clínicas es crucial, ya que su identificación temprana juega un papel importante en el mantenimiento y recuperación de la enfermedad..(Au)

Experience of the biggest School of Medicine in Mexico during the COVID-19 pandemic.

This article was migrated. The article was marked as recommended. The coronavirus 19 disease (COVID-19) pandemic affected virtually all activities worldwide. One of them was education, especially Health Sciences. In the world, many medical schools ceased their face-to-face activities and implemented institutional reorganization actions. According to their characteristics and possibilities, institutions adopted different strategies and tools to continue providing their services online during this health crisis. These situations implied enormous challenges, especially for specific regions, such as Latin America. This article exposes a quick overview of the pandemic experience at the biggest Mexican School of Medicine (UNAM School of Medicine): forecasting, reorganization, actions, challenges, and learnings. Among the most challenging situations experienced were: effective communication strategies; resistance to migrating from face-to-face activities to remote activities; technological development; students and teachers training to implement work and study in virtual spaces; students digital gap; internet and computers access; construction and application of online evaluations; online evaluation of practical skills, and the impossibility of maintaining students in clinical clerkships given the pandemic risks. UNAM School of Medicine reorganized to provide integral care to its community, but it also participated in tasks for Mexico's health and other countries' health benefits. We had a great amount of work, reorganization efforts, and creativity resulting in efficient innovations and new projects. This health crisis showed the best in our community. Actions will remain along the pandemic period and a progressive reincorporation to in-place activities at the end of the health crisis. Some strategies, such as remote activities within teaching, learning, work, evaluation, and research, will be maintained. When this situation ends, we will hopefully have learned and applied those new experiences to improve our School of Medicine, transitioning into a more robust, more united, and enriched community after the crisis caused by this pandemic.

A cytoplasmic Slo3 isoform is expressed in somatic tissues.

Slo3 is a pH-sensitive and weakly voltage-sensitive potassium channel that is essential for male fertility in mouse and whose expression is regarded as sperm-specific. These properties have proposed Slo3 as a candidate target for male contraceptive drugs. Nonetheless, the tissue distribution of Slo3 expression has not been rigorously studied yet. Applying computational and RT-PCR approaches, we identified expression of two short Slo3 isoforms in somatic mouse tissues such as brain, kidney and eye. These isoforms, which seem to result of transcription starting sites between exons 20 and 21, have an identical open reading frame, both encoding the terminal 381 amino acids of the cytosolic Slo3 domain. We corroborated the expression of these isoforms in mouse brain and testis by Western-blot. The complete isoform encoding the Slo3 ion channel was uniquely detected in testis, both at transcript and protein level. Although the functional role of the cytosolic Slo3 isoforms remains to be established, we propose that they may have a functional effect by modulating Slo channels trafficking and/or activity. This study confirms that expression of full-length Slo3 is sperm-specific but warns against developing contraceptive drugs targeting the C-terminal tail of Slo3 channels.

Validez de la glucemia en ayuno como prueba diagnóstica para diabetes gestacional durante el primer trimestre del embarazo / Validity of blood glucose fasting test as diagnostic for gestational diabetes during the first trimester of pregnancy

Resumen Objetivo Determinar la validez de la glucemia en ayuno como valor único para establecer el diagnóstico de diabetes gestacional en el primer trimestre del embarazo. Calcular la sensibilidad, especificidad, valor predictivo positivo y negativo de esta prueba comparándola con el patrón de referencia "curva de tolerancia a la glucosa". Materiales y métodos Estudio observacional, retrospectivo, de casos y controles efectuado de 2014 a 2017. En el grupo de casos se incluyeron pacientes con diagnóstico de diabetes gestacional establecido entre las semanas 24 a 28 de embarazo mediante una curva de tolerancia a la glucosa. Para obtener el grupo control con resultado negativo de la curva se hizo un muestreo aleatorio. El análisis estadístico se efectuó con SPSS Statistics. Para la validez de la prueba se calculó la sensibilidad, especificidad, valores predictivos positivo y negativo. Resultados En el grupo de casos se obtuvieron 204 pacientes: 68.1% con glucemia en ayuno ≥ 92 mg/dL y 31.9% con valores normales de glucosa en el primer trimestre del embarazo. El 50% de las pacientes con sobrepeso y 100% de las pacientes con obesidad tuvieron glucemias ≥ 92 mg/dL. En el grupo control (n = 204) sólo 5.3% tuvo valores ≥ 92mg/dL. La razón de momios para diabetes gestacional con este valor de glucosa en el primer trimestre fue de 37.5; IC95%: 19.1-73.7. La sensibilidad de la prueba fue de 68% y la especificidad de 95%. Valor predictivo positivo de 93% y valor predictivo negativo de 75%. Conclusiones El valor de la glucosa en ayuno como única prueba diagnóstica de diabetes gestacional durante el primer trimestre tiene sensibilidad aceptable y buena especificidad en cualquier paciente con sobrepeso u obesidad.

Abstract Objectives To determine the validity of fasting blood glucose as the only value to perform the diagnosis of gestational diabetes in the first trimester of pregnancy, according to the criteria of the IADPSG. To calculate the sensitivity, specificity, positive and negative predictive value of this test comparing it with the gold standard "Oral glucose tolerance test". Materials and methods Case-control retrospective study carried out from 2014 to 2017. In the case group, patients diagnosed with gestational diabetes were included in the week 24 to 28 of pregnancy through an oral glucose tolerance test. Fasting blood glucose was recorded in the first trimester of pregnancy. A random sampling was done to obtain the control group with the result of the negative test. Statistical analysis was performed with SPSS Statistics. For the valid ity of the test, sensitivity, specificity, PPV, NPV, positive and negative likelihood ratio were calculated. Results In the case group, 204 patients were obtained, 68.1% with fasting blood glucose ≥ 92 mg/dL and 31.9% with normal glucose values in the first trimester of pregnancy. 50% of overweight patients and 100% of patients with obesity had glycemia ≥ 92 mg/dL. In the control group of 204 patients, only 5.3% had values ≥ 92 mg/dL. The OR for the development of gestational diabetes with this glucose value in the first trimester was 37.5 95%CI: 19.1-73.7. The sensitivity of the test was 68%, specificity 95%. Conclusions The fasting glucose value as the only diagnostic test of gestational diabetes during the first trimester has an acceptable sensitivity and a good specificity especially in patients with overweight or obesity.

Understanding knowledge, attitudes, and behaviors related to influenza and the influenza vaccine in US-Mexico border communities.

Hispanics are less likely to receive the influenza vaccine compared to other racial and ethnic groups in the US. Hispanic residents of the US-Mexico border region may have differing health beliefs and behaviors, and their cross-border mobility impacts disease control. To assess beliefs and behaviors regarding influenza prevention and control among border populations, surveys were conducted at border clinics. Of 197 respondents, 34 % reported conditions for which vaccination is indicated, and travel to Mexico was common. Few (35 %) believed influenza could make them 'very sick', and 76 % believed they should take antibiotics to treat influenza. Influenza vaccine awareness was high, and considered important, but only 36 % reported recent vaccination. The belief that influenza vaccination is 'very important' was strongly associated with recent vaccination; "Didn't think about it" was the most common reason for being un-vaccinated. Misconceptions about influenza risk, prevention and treatment were common in this Hispanic border population; improved educational efforts and reminder systems could impact vaccination behaviors.

Human health risk of dietary intake of organochlorine pesticide residues in bovine meat and tissues from Veracruz, México.

Tissue distribution patterns of organochlorine pesticides in bovine carcasses varied significantly among seasons, geographic locations and tissues. The highest concentrations of Σ-DDT during the dry season were detected in lungs from Paso de Ovejas (2,834.90µg/kg lipid) and, during the rainy season, Lindane and Σ-HCH in muscle and lung samples from Paso de Ovejas (995.80 and 1,690.10µg/kg lipid). Estimated daily intakes of γ-HCH and Σ-DDT (3.35 and 1.22µg/kg bw/day) through consumption of muscle tissues from Paso de Ovejas and Puente Nacional during the rainy season showed the highest contribution. During the rainy season the highest non-cancer Hazard Ratios estimated corresponded to γ-HCH (3.97) and Σ-DDT (4.39) detected in muscle samples from Puente Nacional. The highest Hazard Ratios of cancer risk to the 95th centile daily consumption through meat corresponded to p,p'-DDT from Alvarado (7.76E+06) and from Paso de Ovejas for γ-HCH (1.50E+05) during rainy season. The results indicate potential non- and carcinogenic risks to consumer health through meat consumption.

[Letrozole vs. tamoxifen as neoadjuvant therapy for postmenopausal patients with hormone-dependent locally-advanced breast cancer]. / Letrozol vs tamoxifeno como terapia neoadyuvante para pacientes posmenopáusicas con cáncer de mama hormono-dependiente localmente avanzado.

BACKGROUND: Previous studies demonstrated that Letrozole (aromatase inhibitor) and tamoxifen (selective modulator of estrogen receptors) are effective in the treatment of postmenopausal women with locally advanced tumors, stage III and hormone dependent. OBJECTIVE: To present display the complete clinical answer incidence and the complete pathological answer with the use of induction hormonotherapy. METHODS: Put-analysis in 40 patients with breast cancer, to chanalicular infiltrated, eligible were treated in a prospective study, to double blind person, using per os: letrozol, 2.5 mg; tamoxifen, 20 mg, known widely like selective modulator of estrogen receivers; oral route, during 36 consecutive months. Reports at the beginning were taken, subsequent to 3, 6 and 12 months to evaluate the frequency of complete respond. The patients, who did not show answer neoadjuvant therapy, were put under treatment with radiotherapy. The patients who showed good partial pathological respond, or clinical partial respond, went candidates to radical mastectomy. According to the protocol of the study, the patients subsequent to surgery who showed partial pathological respond or complete pathological respond, continued adjuvant handling adyuvant therapy by 2 years consecutive or until the presence of progression of the disease. It was used like statistical method Chi2, with p of Table cloth to evaluate the differences. RESULTS: During a period of 3 years, january of the 2003 to january of the 2005, 2 groups of patients, 40 studied altogether; the age average was of 65,5 years, with a rank of 55 to 75 years with breast cancer, stages: IIA to IIIB. Without complete respond 25% of the group with tamoxifen; 20% with letrozol Those patients happened to radiotherapy. The collateral effects of the use of hormonotherapy with letrozol appeared in a 55% and with the use of tamoxifen in a 60% of the patients with breast cancer (p = 0.5). They did not respond to neoadyuvant therapy (hormonal receptors < to 30%): with letrozol 19% of them and 25% with tamoxifen; reason why they received treatment with radiotherapy. All patients candidates to surgery, were benefitted with the mastectomy handling. CONCLUSIONS: Results although preliminary, suggest that neoadyuvant treatment with hormone-therapy in postmenopausal patients with breast cancer, have good prognosis. Induction therapy, were better tolerated, with greater effectiveness and improved the clinical and objective respond in women with breast cancer in the postmenopausal. Work serves as tool to determine the indication to us of induction hormonotherapy; and identify to those patients with breast cancer, locally advanced in post menopause with better prognosis to be rescued with radical mastectomy. Study needs more background and show the impact of letrozol, as hormonotherapy used in neoadjuvancy, to confirm if relieves period without disease or survives, before mastectomy. In a near future, it shall important to investigate if is useful the radical mastectomy in those postmenopausal patients with complete objective respond, after the use of an aromatase inhibitor.

[A clinical guideline for diagnosis and treating of diabetes during pregnancy]. / Guía de práctica clínica. Diagnóstico y tratamiento de la diabetes en el embarazo.

BACKGROUND: Metabolic disturbance commonly occurs during pregnancy and perinatal outcome harms, with increased maternal-fetal morbidity. The prevalence of diabetes during pregnancy in Mexico is 7%. OBJECTIVE: To develop a guideline available to the staff of the first, second and third level of care, that includes recommendations based on the best available evidence. METHODS: Clinical questions were formulated and structured. Standardized sequence was established to search for practice guidelines from the clinical questions raised on diagnosis and treatment of diabetes and pregnancy. The working group selected clinical practice guidelines. We found eleven guidelines which took many of the recommendations. For recommendations not included in the reference guides the search process was conducted in PubMed and Cochrane Library. The results were expressed as levels of evidence and grade of recommendation. CONCLUSIONS: Diabetes mellitus during pregnancy increases perinatal morbidity and mortality. The recommendations in this evidence-based guide will help to make diagnosis and treatment standardized to reduce the consequences of disease.